Difference between revisions of "Cholecystectomy"
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| | |Elevated PACE vs laparoscopic<ref>{{Cite journal|last=Liu|first=Jason B.|last2=Liu|first2=Yaoming|last3=Cohen|first3=Mark E.|last4=Ko|first4=Clifford Y.|last5=Sweitzer|first5=Bobbie J.|date=2018-02-01|title=Defining the Intrinsic Cardiac Risks of Operations to Improve Preoperative Cardiac Risk Assessments|url=https://pubs.asahq.org/anesthesiology/article/128/2/283/17742/Defining-the-Intrinsic-Cardiac-Risks-of-Operations|journal=Anesthesiology|language=en|volume=128|issue=2|pages=283–292|doi=10.1097/ALN.0000000000002024|issn=0003-3022}}</ref> | ||
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Revision as of 09:51, 5 April 2021
Cholecystectomy
| Anesthesia type |
General |
|---|---|
| Airway |
Endotracheal tube |
| Lines and access |
Peripheral IV |
| Monitors |
Standard ASA |
| Primary anesthetic considerations | |
| Preoperative |
NG Tube |
| Intraoperative |
Rapid sequence intubation |
| Postoperative |
PONV |
| Article quality | |
| Editor rating | |
| User likes | 1 |
A cholecystectomy is generally performed to treat symptomatic cholelithiasis and other gallbladder conditions. This is one of the most common procedures performed in hospitals in the United States. Of the more than 20 million people in the US with gallstones, about 30% will eventually require cholecystectomy to relieve symptoms or treat complications. A cholecystectomy can be performed laparoscopically or as an open procedure. Surgical practice has largely transitioned to the laparoscopic approach. The rate of conversion to an open operation is 2-3% for elective gallbladder surgery and ~10% for acute cholecystitis[1].
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Respiratory |
|
| Cardiovascular |
|
| Renal |
|
| Gastrointestinal | |
| Hematologic |
|
| Endocrine | |
| Other |
Labs and studies
- CBC
- Chemistry Panel
Operating room setup
- NG tube
Patient preparation and premedication
- Midazolam
Regional and neuraxial techniques
- Consider epidural for open approach
Intraoperative management
Monitoring and access
- Standard ASA monitors
- 5-lead EKG
- Urinary catheter
- NG tube
- 1-2 peripheral IVs (16-18 gauge)
- In unstable patients or if open cholecystectomy, consider arterial line and central access
Induction and airway management
- Standard induction
- In unstable patients, consider etomidate (BP control) and rapid sequence intubation (RSI)
Positioning
- Supine, Trendelenburg
- Secure and tuck arms
Maintenance and surgical considerations
- Intraoperative insufflation may cause
- Resp: atelectasis, decrease FRC, increase PIPs, and increase CO2. May also cause endobronchial intubation
- GI: gastric content regurgitation
- Cardiac: decreased cardiac output
Emergence
- PONV prophylaxis
Postoperative management
Disposition
Pain management
- NSAIDs and acetaminophen for mild pain
- Opioids for breakthrough pain. Consider PCA for open cases
Potential complications
- PONV
- Subcutaneous emphysema (from insufflation)
- Bowel injury
Procedure variants
| Open Cholecystectomy | Laparoscopic Cholecystectomy | |
|---|---|---|
| Unique considerations | ||
| Position | Supine | Supine |
| Surgical time | 2-4 hours | 0.5-2 hours |
| EBL | 250mL | Minimal |
| Postoperative disposition | PACU | PACU |
| Mortality | ||
| Morbidity | Elevated PACE vs laparoscopic[2] | |
| Pain | 5-7 | 3 |
References
- ↑ Jaffe, Richard A; Schmiesing, Clifford A; Golianu, Brenda (2014). Anesthesiologist's manual of surgical procedures. ISBN 978-1-4963-0594-7. OCLC 888551588.
- ↑ Liu, Jason B.; Liu, Yaoming; Cohen, Mark E.; Ko, Clifford Y.; Sweitzer, Bobbie J. (2018-02-01). "Defining the Intrinsic Cardiac Risks of Operations to Improve Preoperative Cardiac Risk Assessments". Anesthesiology. 128 (2): 283–292. doi:10.1097/ALN.0000000000002024. ISSN 0003-3022.